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Non-alcoholic fatty liver disease and cardiovascular risk: metabolic aspects and novel treatments

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Abstract

Non-alcoholic fatty liver disease (NAFLD) is usually a silent disease that occurs in a very high proportion of people with features of the metabolic syndrome, including overweight, insulin resistance and type 2 diabetes. Because obesity and type 2 diabetes are now extremely common in Westernised societies, it is likely that the prevalence of NAFLD increases markedly in the future. Although previously it was thought that NAFLD was harmless, it is now recognised that NAFLD can be a progressive liver condition that increases risk of cirrhosis, end-stage liver disease and hepatocellular carcinoma. Additionally, liver fat accumulation causes insulin resistance and increases risk of type 2 diabetes. Increasing evidence now shows NAFLD is a risk factor for cardiovascular disease (CVD). The purpose of this review is to briefly discuss the pathogenesis of NAFLD, to describe the relationship between NAFLD and CVD and the mechanisms linking both conditions and to discuss some of the treatment options (including lifestyle, nutrition and drugs) that may influence both NAFLD and risk of CVD.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BMI:

Body mass index

CVD:

Cardiovascular disease

HDL:

High-density lipoprotein

IL:

Interleukin

IR:

Insulin resistance

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

NEFA:

Non-esterified fatty acid (‘free fatty acid’)

NF-κB:

Nuclear factor κB

RAS:

Renin angiotensin system

TNF-α:

Tumour necrosis factor α

TG:

Triglyceride

VLDL:

Very low density lipoprotein

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Acknowledgments

E. Scorlett, P.C. Calder and C.D. Byrne are supported in part by the Southampton National Institute for Health Research Biomedical Research Unit in Nutrition, Lifestyle and Obesity.

Disclosures

The authors are undertaking the WELCOME study (Wessex Evaluation of fatty Liver and Cardiovascular markers in NAFLD [non-alcoholic fatty liver disease] with OMacor thErapy) in people with NAFLD. The WELCOME study is a phase IV trial that is testing the effects of high dose purified n-3 long chain fatty acids (Omacor–Solvay/Abbott/Pronova 4 grames o.d.) on a range of liver and cardio-metabolic outcomes. The trial will be completed in 2012 (www.clinicaltrials.gov registration number NCT00760513).

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  1. Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK

    E. Scorletti, P. C. Calder & C. D. Byrne

  2. NIHR Biomedical Research Unit in Nutrition, Lifestyle and Obesity, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

    E. Scorletti, P. C. Calder & C. D. Byrne

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  1. E. Scorletti
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Scorletti, E., Calder, P.C. & Byrne, C.D. Non-alcoholic fatty liver disease and cardiovascular risk: metabolic aspects and novel treatments. Endocrine 40, 332–343 (2011). https://doi.org/10.1007/s12020-011-9530-x

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